Vascular access ports and related methods

ABSTRACT

Ports for accessing a vessels within a patient include passageways that can guide needles or other access devices directly into the vessels. The ports can be implanted subcutaneously within a patient. Some ports may be used in the creation and use of vascular access buttonholes.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit under 35 U.S.C. §119(e) of pendingU.S. Provisional Patent Application No. 61/148,372, titled VASCULARACCESS METHODS, APPARATUS AND SYSTEMS, filed on Jan. 29, 2009, and ofpending U.S. Provisional Patent Application No. 61/229,023, titledSURGICALLY IMPLANTED DIRECT VASCULAR ACCESS PORT METHOD AND APPARATUS,filed on Jul. 28, 2009, the entire contents of each of which are herebyincorporated by reference herein.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

The invention was made with support from the U.S. Government under GrantNo. SBIR R43 CA 139608 and Grant No. SBIR R44 CA 139608, which wereawarded by the National Institutes of Health. The U.S. Government hascertain rights in the invention.

TECHNICAL FIELD

The present disclosure relates to subcutaneous vascular access ports andrelated systems and methods.

BRIEF DESCRIPTION OF THE DRAWINGS

The written disclosure herein describes illustrative embodiments thatare non-limiting and non-exhaustive. Reference is made to certain ofsuch illustrative embodiments that are depicted in the figures, inwhich:

FIG. 1 is a perspective view of an embodiment of a vascular access port;

FIG. 2 is a front elevation view thereof;

FIG. 3 is a rear elevation view thereof;

FIG. 4 is a top plan view thereof;

FIG. 5 is a bottom plan view thereof;

FIG. 6 is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 7 is a cross-sectional view of the vascular access port of FIG. 1taken along the view line 7-7 in FIG. 2;

FIG. 8 is a perspective partial cutaway view of the vascular access portof FIG. 1 coupled with a vessel;

FIG. 9A is a perspective view of a stage of an illustrative method ofimplanting an embodiment of a vascular access port in a patientdepicting the creation of an incision;

FIG. 9B is a perspective view of another stage of the method of FIG. 9Ain which a vessel is exposed;

FIG. 9C is a perspective view of another stage of the method of FIG. 9Ain which an attachment is made between the vascular access port and thevessel;

FIG. 9D is a perspective view of another stage of the method of FIG. 9Ain which additional attachments have been made between the vascularaccess port and the vessel;

FIG. 9E is a perspective view of another stage of the method of FIG. 9Ain which the incision has been closed;

FIG. 10A is a perspective view of a stage of another illustrative methodof implanting an embodiment of a vascular access port depicting thecreation of an incision in the skin of a patient;

FIG. 10B is a perspective view of another stage of the method of FIG.10A in which adventitia of a vessel is isolated;

FIG. 10C is a perspective view of another stage of the method of FIG.10A in which in incision is made in the adventitia;

FIG. 10D is a perspective view of another stage of the method of FIG.10A in which a pocket is formed in the adventitia;

FIG. 10E is a perspective view of another stage of the method of FIG.10A in which an embodiment of a vascular access port is inserted intothe pocket;

FIG. 10F is a perspective view of another stage of the method of FIG.10A in which attachments have been made between the vascular access portand the vessel;

FIG. 10G is a perspective view of another stage of the method of FIG.10A in which the incision in the skin of the patient has been closed;

FIG. 11A is a cross-sectional view of a palpations stage of anillustrative method relating to the creation and use of a buttonholeaccess site to access a lumen of a vessel;

FIG. 11B is a cross-sectional view of another stage of the method ofFIG. 11A in which a needle having a sharp tip is inserted into the lumenof the vessel via an embodiment of a vascular access port;

FIG. 11C is a cross-sectional view of another stage of the method ofFIG. 11A in which pressure is applied to the skin of the patient;

FIG. 11D is a cross-sectional view of another stage of the method ofFIG. 11A in which an insertion tract and a buttonhole access site havebeen formed;

FIG. 11E is a cross-sectional view of another stage of the method ofFIG. 11A in which a needle having a blunt tip is inserted into the lumenof the vessel via the insertion tract, the vascular access port, and thebuttonhole access site;

FIG. 12 is a cross-sectional view of a stage of another illustrativemethod relating to the creation and use of a buttonhole access site toaccess a lumen of a vessel;

FIG. 13 is a bottom plan view of a filleted vessel that bears anembodiment of a buttonhole access site that has been created via anembodiment of a vascular access port;

FIG. 14A is a perspective view of an embodiment of a vascular accesssystem that can be used for hemodialysis;

FIG. 14B is a perspective view of another embodiment of a vascularaccess system that can be used for hemodialysis;

FIG. 15A is a perspective view of another embodiment of a vascularaccess port;

FIG. 15B is a rear elevation view thereof;

FIG. 15C is a front elevation view thereof;

FIG. 15D is a top plan view thereof;

FIG. 15E is a bottom plan view thereof;

FIG. 15F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 15G is a cross-sectional view thereof;

FIG. 16A is a perspective view of another embodiment of a vascularaccess port;

FIG. 16B is a rear elevation view thereof;

FIG. 16C is a front elevation view thereof;

FIG. 16D is a top plan view thereof;

FIG. 16E is a bottom plan view thereof;

FIG. 16F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 16G is a cross-sectional view thereof;

FIG. 17A is a perspective view of another embodiment of a vascularaccess port;

FIG. 17B is a rear elevation view thereof;

FIG. 17C is a front elevation view thereof;

FIG. 17D is a top plan view thereof;

FIG. 17E is a bottom plan view thereof;

FIG. 17F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 17G is a cross-sectional view thereof;

FIG. 18A is a perspective view of another embodiment of a vascularaccess port;

FIG. 18B is a rear elevation view thereof;

FIG. 18C is a front elevation view thereof;

FIG. 18D is a top plan view thereof;

FIG. 18E is a bottom plan view thereof;

FIG. 18F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 18G is a cross-sectional view thereof;

FIG. 19A is a perspective view of another embodiment of a vascularaccess port;

FIG. 19B is a rear elevation view thereof;

FIG. 19C is a front elevation view thereof;

FIG. 19D is a top plan view thereof;

FIG. 19E is a bottom plan view thereof;

FIG. 19F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 19G is a cross-sectional view thereof;

FIG. 20A is a perspective view of another embodiment of a vascularaccess port;

FIG. 20B is a rear elevation view thereof;

FIG. 20C is a front elevation view thereof;

FIG. 20D is a top plan view thereof;

FIG. 20E is a bottom plan view thereof;

FIG. 20F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 20G is a cross-sectional view thereof;

FIG. 21A is a perspective view of another embodiment of a vascularaccess port;

FIG. 21B is a rear elevation view thereof;

FIG. 21C is a front elevation view thereof;

FIG. 21D is a top plan view thereof;

FIG. 21E is a bottom plan view thereof;

FIG. 21F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 21G is a cross-sectional view thereof;

FIG. 22A is a perspective view of another embodiment of a vascularaccess port;

FIG. 22B is a rear elevation view thereof;

FIG. 22C is a front elevation view thereof;

FIG. 22D is a top plan view thereof;

FIG. 22E is a bottom plan view thereof;

FIG. 22F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 22G is a cross-sectional view thereof;

FIG. 23A is a perspective view of another embodiment of a vascularaccess port;

FIG. 23B is a rear elevation view thereof;

FIG. 23C is a front elevation view thereof;

FIG. 23D is a top plan view thereof;

FIG. 23E is a bottom plan view thereof;

FIG. 23F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 23G is a cross-sectional view thereof;

FIG. 24A is a perspective view of another embodiment of a vascularaccess port;

FIG. 24B is a rear elevation view thereof;

FIG. 24C is a front elevation view thereof;

FIG. 24D is a top plan view thereof;

FIG. 24E is a bottom plan view thereof;

FIG. 24F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 24G is a cross-sectional view thereof;

FIG. 25A is a perspective view of another embodiment of a vascularaccess port;

FIG. 25B is a rear elevation view thereof;

FIG. 25C is a front elevation view thereof;

FIG. 25D is a top plan view thereof;

FIG. 25E is a bottom plan view thereof;

FIG. 25F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 25G is a cross-sectional view thereof;

FIG. 26A is a perspective view of another embodiment of a vascularaccess port;

FIG. 26B is a rear elevation view thereof;

FIG. 26C is a front elevation view thereof;

FIG. 26D is a top plan view thereof;

FIG. 26E is a bottom plan view thereof;

FIG. 26F is a right side elevation view thereof, wherein a left sideelevation view is a mirror image of the right side elevation view;

FIG. 26G is a cross-sectional view thereof;

FIG. 27A is a perspective view of another embodiment of a vascularaccess port;

FIG. 27B is a perspective view of the vascular access port of FIG. 27Acoupled to a vessel;

FIG. 28 is a perspective view of an embodiment of a vascular accesssystem;

FIG. 29 is a perspective view of another embodiment of a vascular accessport;

FIG. 30 is a cross-sectional view of another embodiment of a vascularaccess port; and

FIG. 31 is a perspective view of an embodiment of a vascular accesssystem that can be used for the external treatment of blood.

DETAILED DESCRIPTION

Certain embodiments of vascular access ports described herein areconfigured to be implanted subcutaneously in a patient for relativelylong or indefinite periods. The vascular access ports can be implantedin any suitable manner and can be substantially fixed relative to avessel wall once implanted. For example, in some implantation methods, abottom surface of a vascular access port placed in contact with thetunica adventitia of a vessel and the port is secured to the vessel viaone or more sutures that extend through at least a portion of everylayer of the vessel. In further embodiments, a portion of the tunicaadventitia is separated or removed from a blood vessel such that thebottom surface of a port is relatively close to the tunica media layerof the blood vessel, and the port is secured to the vessel via one ormore sutures that extend through at least a portion of the tunicaadventitia layer and substantially entirely through the media and thetunica intima layers. The surface of the port that contacts the vesselwall can comprise an opening through which an access device, such as aneedle, can be inserted into a lumen of the blood vessel. The vascularaccess ports can be well-suited for buttonhole cannulation techniques inwhich buttonhole access sites are created in vessel walls and/or areused to access the vessels. The term “buttonhole” is used herein in itsordinary sense in the field of vascular access (e.g., in the field ofhemodialysis), particularly in the context of cannulation techniques,and the term can include single-site cannulation holes that areapproximately the same size as access devices that are insertedtherethrough (e.g., needles or other cannulation devices), and that canpermit relatively easy insertion of the access devices as compared withother areas along a vessel wall. Similarly, the ports can be well-suitedfor the creation and/or use of tracts through the skin of a patientthrough which the buttonholes can be repeatedly accessed. These andother features and advantages of various embodiments of vascular accessports, of systems that employ the ports, and of methods of implantingand using the ports will be apparent from the disclosure herein.

FIGS. 1-7 illustrate an embodiment of a vascular access port 100. Thevascular access port 100 includes a base 102 and a body 104. In theillustrated embodiment, the base 102 and the body 104 are integrallyformed as a unitary piece, and the body 104 extends away from the base102. The base 102 is elongated in a longitudinal direction. Inparticular, the illustrated base 102 defines a substantially rectangularperimeter 106 that extends a greater distance in a longitudinaldirection than it does in a transverse direction (see, e.g., FIG. 5).The edges and corners of the rectangular perimeter 106 can be rounded,which can prevent trauma to surrounding tissue when the vascular accessport 100 is implanted.

The base 102 can include a base surface or bottom surface 108 that isconfigured to face a vessel when the vascular access port 100 is coupledto the vessel. The bottom surface 108 can be configured to conform to acontour of a wall of the vessel. For example, the bottom surface 108 ofthe base 102 can be bowed in the transverse direction and can have aradius of curvature that is substantially the same as a radius ofcurvature of an outer surface of a vessel to which the vascular accessport 100 is to be attached. The bowed bottom surface 108 can define acavity 110 (see FIGS. 2 and 3) into which at least a portion of acircumference of a vessel can be received. In the illustratedembodiment, the width and the curvature of the bottom surface 108 aresuch that the cavity 110 is sized to receive a substantial portion ofthe circumference of a vessel therein. Such a configuration can permitthe bottom surface 108 to form a stable contact with the vessel. Othersuitable arrangements are also possible, as discussed below.

The base 102 can include one or more connection flanges 112 that extendabout a least a portion of a periphery of the base 102. In theillustrated embodiment, a first connection flange 112 extends about afront end of the base 102 and a second connection flange 112 is at aback end of the base 102. One or more attachment channels or attachmentpassages 114 can extend through the connection flanges 112. Theattachment passages 114 can be configured to permit one or more ties orattachment devices 116 to extend therethrough so as to attach thevascular access port 100 to a vessel (see, e.g., FIGS. 8, 9C, 10F, 11A,and 12), as discussed further below. Any suitable attachment devices 116may be used, such as one or more sutures, pinch rings, hooks, or wires.Accordingly, in some embodiments, one or more of the attachment passages114 may be referred to as suture holes. As further discussed below, inthe illustrated embodiment, the base 102 includes a centrally situatedattachment passage 114 at each of the front and rearward ends thereof.

The body 104 can extend upwardly from the base 102. In the illustratedembodiment, the body rises upwardly along a central verticallongitudinal plane 120 (see FIGS. 2 and 4) of the vascular access port100. With reference to FIG. 4, the body 104 can expand outwardly fromthe central vertical longitudinal plane 120 and can widen in a rearwarddirection. Additionally, as shown in FIGS. 3, 4, and 6, a pinnacleregion 122 of the body 104 can be positioned along the central verticallongitudinal plane 120 and at approximately a longitudinal center of thebody 104. It is noted that directional terms, such as bottom, front, andrearward, are used relative to the orientation of the vascular accessport 100 shown in FIG. 1. Such directional terms are not intended tolimit the possible orientations of the vascular access port 100 within apatient. For example, in some embodiments, the front end of the vascularaccess port 100 may be oriented upstream from the rearward end thereofwhen the port 100 is coupled to a vessel, whereas in other embodiments,the front end may be oriented downstream from the rearward end.

A guidance passageway 130 can extend through the body 104. In theillustrated embodiment, the guidance passageway 130 includes a funnelregion 132 and a channel 134. The funnel region 132 defines a relativelylarge entry mouth 136, which extends about or circumscribes the proximalend or proximal opening thereof, and the funnel region 132 narrows fromthe entry mouth 136 in a forward and downward direction. In theillustrated embodiment, a forward end of the funnel region 132transitions into the channel 134. The funnel region 132 can include abase surface 138 that projects rearwardly from the channel 134 and thatflares outwardly in the rearward direction. As shown in FIG. 7, the basesurface 138 of the funnel region 132 can be angled upwardly (in arearward direction) relative to the bottom surface 108 of the base 102.The funnel region 132 can further include wings 140 that each curveupwardly and outwardly from the base surface 138 and that are eachjoined to a backstop portion 142 at a forward end thereof. As shown inFIGS. 4 and 5, the wings 140 can extend outwardly past the perimeter 106of the base 102 so as to provide for a wide entry mouth 136 of thefunnel region 132. The backstop portion 142 can rise upwardly from anupper surface of the channel 134 and may include a surface that isdirected substantially vertically. The backstop portion 142 can span thechannel 134, and at least a portion thereof can be positioned directlyabove the channel 134.

The funnel region 132 can fully encompass an entrance end of the channel134 and can encourage a tip of an access device 144, such as a needle(see FIG. 11B), to enter the channel 134. The funnel region 132 thus canserve as an enlarged target area that can assist in directing an accessdevice 144 to a desired portion of a vessel, as discussed further below.The funnel region 132 can comprise a material that can prevent ordiscourage a tip of an access device 144 from embedding therein orremoving a portion thereof as the tip moves toward the channel 134. Forexample, in various embodiments, the funnel region 132 can comprisetitanium, stainless steel, a rigid plastic, or a similar material.

At least a portion of the entry mouth 136 of the funnel region 132 caninclude a palpation projection 146, such as a palpation ridge. In theillustrated embodiment, the palpation projection 146 is substantiallyU-shaped and extends over the wings 140 and the backstop portion 142 ofthe funnel region 132, and the pinnacle region 122 of the body 104 islocated at a forward end of the palpation projection 146. The palpationprojection 146 can be rounded or radiused so as to be free from sharpedges that could lead to tissue erosion. As further discussed below, thepalpation projection 146 can be used to locate the vascular access port100 and/or confirm an orientation thereof when the port 100 ispositioned subcutaneously in a patient.

The entry mouth 136 of the funnel region 132 may be used to assist inachieving hemostasis after removal of an access device 144 from thevascular access port 100. To this end, the palpation projection 146 maysubstantially define a plane, in some embodiments. As shown in FIG. 6,the palpation projection 146 of the illustrated embodiment is nearly orsubstantially planar, as it is not perfectly planar due to a slightcurvature in the longitudinal direction. The palpation projection 146also exhibits a slight curvature in the transverse direction, as can beseen in FIG. 3. Moreover, in the illustrated embodiment, a rearward edgeof the entry mouth 136 smoothly transitions into the palpationprojection 146 at either end thereof and is only slightly below thesubstantially planar region defined by the palpation projection 146.Accordingly, as further discussed below, a seal can readily be formedabout a periphery of the entry mouth 136 of an implanted vascular accessport 100 by pressing tissue that surrounds the port 100 against theentry mouth 136.

With reference to FIG. 7, the channel 134 can extend through the base102, and a bottom end of the channel 134 can define an opening 150 inthe bottom surface 108 of the base 102. The opening 150 may be referredto as a distal opening 150 of the guidance passageway 130. The channel134 can be configured to constrain movement of one or more accessdevices 144 inserted individually therethrough along a predetermined orrepeatable path toward the opening 150. Accordingly, when the vascularaccess device 100 is fixed relative to a vessel, the channel 134 and theopening 150 can cause the one or more access devices 144 to cannulatethe same portion of the vessel. In certain embodiments, the channel 134defines a substantially constant inner diameter D along a lengththereof, which can constrain the movement of an access device 144 thathas an outer diameter that is slightly smaller than the diameter D. Forexample, in the illustrated embodiment, the channel 134 is substantiallycylindrical and can constrain movement of a substantially cylindricalaccess device 144 (e.g., a fistula needle) that has an outer diameterslightly smaller than the diameter D (see FIG. 11B). The diameter Dand/or the length of the channel 134 can be selected to achieve adesired amount of constraint for a given access device 144.

With continued reference to FIG. 7, the channel 134 can define a centralaxis AX, which can define an acute angle α relative to the bottomsurface 108. For example, in the illustrated embodiment, the axis AX anda longitudinal line along the bottom surface 108 form the angle α. InFIG. 7, the longitudinal line is represented in FIG. 7 by a line L thatdefines a longitudinal length of the base 10. When the vascular accessport 100 is connected to a vessel, the longitudinal line L can besubstantially parallel to a longitudinal axis of a lumen of the vessel(see FIG. 11A). Accordingly, in the illustrated embodiment, the channel134 can constrain movement of an access device 144 along a path that isboth nonparallel and non-orthogonal to the lumen of the vessel. Inparticular, the channel 134 can constrain movement of the access device144 along a path that is at or is approximately at the angle α relativeto the lumen of the vessel. In various embodiments, the angle α can havea value that is no greater than about 15, 20, 25, 30, 35, 45, or 60degrees; can have a value that is no less than about 10, 15, 20, 25, 30,35, 45, or 60 degrees; or can have a value that is within a range offrom about 30 degrees to about 60 degrees, from about 15 degrees toabout 45 degrees, or from about 20 degrees to about 35 degrees. Asfurther discussed below, some protocols for the creation and use ofbuttonhole cannulation sites can require introduction of a needle into avessel at a designated acute angle. Accordingly, certain embodiments ofthe vascular access port 100 can be configured for use with suchprotocols, and the angle α can be selected to correspond with the angledesignated by the protocol.

As previously discussed, the diameter D defined by the channel 134 canbe larger than a diameter of an access device 144 that is insertedthrough the channel 134. In some embodiments, the channel 134 is largerthan the access device 144 by a sufficient amount to allow the accessdevice 144 to pass through it easily or with little or no resistance.Reduction or elimination of insertion and removal forces between anaccess device 144 and the channel 134 can assist in maintaining a secureattachment between the vascular access port 100 and a vessel over thecourse of multiple insertion and removal events. Moreover, in theillustrated embodiment, the channel 134 is open, unobstructed, clear,free, or vacant. Stated otherwise, the channel 134 is devoid of closureapparatus, such as, for example, septums, valves, obturators, etc.,which could be used to selectively open the channel 134 prior to orduring insertion of an access device 144 therein, or which could be usedto selectively close the channel 134 during or after removal of anaccess device 144 therefrom. The term “closure apparatus,” as usedherein, is directed to mechanical, electromechanical, or othersynthetic, foreign, or non-native devices or systems that may bemanufactured outside of a patient and introduced into a patient, butdoes not include natural or patient-generated materials that may closethe channel 134, such as, for example, clotted blood, tissue ingrowth,or vascular structures, such as a neointima or a pseudo vessel wall.

In certain embodiments, a configuration of the channel 134, or moregenerally, the guidance passageway 130, can remain unchanged uponinsertion of an access device 144 therein or removal of an access device144 therefrom, which may result, at least in part, from an absence ofclosure apparatus within the channel 134 or the guidance passageway 130.More generally, a configuration of the vascular access port 100 canremain unchanged upon insertion of an access device 144 therein orremoval of an access device 144 therefrom. Stated otherwise, in certainembodiments, no portion of one or more of the channel 134, the guidancepassageway 130, and the vascular access port 100 may be deformed,rotated, translated, pivoted, expanded, contracted, or otherwise movedrelative to remaining portions of one or more of the channel 134, theguidance passageway 130, and the vascular access port 100. Any resistiveforces to the insertion or removal of an access device 144 that might beprovided by closure apparatus thus are absent during use of the vascularaccess port 100. Methods by which hemostasis may be achieved via thevascular access port 100 in the absence of closure apparatus arediscussed below.

Manufacture of embodiments of the vascular access port 100 can befacilitated by their lack of closure apparatus. For example, in theillustrated embodiment, the vascular access port 100 comprises a unitarypiece and/or comprises a single material, and it is devoid of movingparts. Likewise, in the illustrated embodiment, the guidance passageway130 is defined by a single unitary piece and/or by a single material,and it is devoid of moving parts. Other or further embodiments maycomprise multiple parts that are fixedly attached to each other in anon-separable fashion. Embodiments of the vascular access port 100 canbe manufactured via any suitable method, such as machining, die casting,injection molding, etc., and may comprise any suitable biocompatiblematerial, such as, for example, titanium, stainless steel, rigidplastic, etc. In some embodiments, the vascular access port 100comprises a resorbable material. For example, in various embodiments,the vascular access port 100 can comprise one or more of caprilactoneand glycolide (e.g., Panacryl, in proportions of about 90% and 10%,respectively); ε-caprolactone; cellulose; ethylene oxide with propyleneoxide (e.g., Pleuronic F-108); ethylene oxide with block polymer (e.g.,DynaGraft proloxamer); glycolide, dioxanone, and trimethylene carbonate(e.g., Biosyn, in proportions of about 60%, 14%, and 26%, respectively);glycolide and ε-caprolactone (e.g., Monocryl); hyaluronic acid ester(e.g., Hyaff); poly(butylene-terephthalate)-co-(polyethyleneglycol)(e.g., Poly-active, Osteo-active); polydioxanon (e.g., PDS);polyethyleenoxyde, polyglactin (e.g. Vicryl, Vicryl Rapide, Vicryl Plus,Polysorb); poly-glecapron (e.g., Monocryl); polyglycolic acid (e.g.,Dexon); polyglyconate (e.g., Maxon); polyglyceride (e.g., Trilucent);polylactic acid (e.g., PLLA); poly L-lactic acid (PLLA) and polyglycolicacid (PGA) (e.g., in proportions of about 82% and 18%, respectively);poly L-lactic acid (PLLA) and copolymer (e.g., Lactosorb);poly-L-lactide, poly-D-lactide, and poly-glycolide; polyvinylalcohol(e.g., Bioinblue); polysaccharide; and propylene oxide.

In other embodiments, the vascular access port 100 can be formed of acombination of materials. For example, as discussed further below, insome embodiments, the guidance passageway 130 can be formed of amaterial that remains rigid indefinitely, or for a relatively longperiod, such as titanium, stainless steel, or a first type of resorbablematerial, and other portions of the vascular access port 100 cancomprise a resorbable material, such as, for example, a second type ofresorbable material that is resorbed within the body of a patient muchquicker than is the first type of resorbable material.

With reference to FIG. 5, the bottom surface 108 of the base 102 caninclude any suitable ingrowth-inducing covering 152, which canfacilitate integration or ingrowth of tissue in order to provide orenhance an attachment between a vessel and the vascular access port 100.In some embodiments, the ingrowth-inducing covering comprises a porousor roughened texture, which can be formed in any suitable manner. Forexample, in some embodiments, the texture is provided by compaction andsintering of metallic beads or powders, such as titanium beads, onto thebottom surface 108. In some embodiments, the beads may have a diameterof about 5 thousandths of an inch (i.e., approximately 0.13 millimeters)or smaller. In other or further embodiments, the ingrowth-inducingcovering 152 can be formed by machining, sandblasting, laser etching, orinjection molding of the bottom surface 108, or by attaching to thebottom surface 108 a fabric, such as polyester, Dacron®, or e-PTFE.

The ingrowth-inducing covering 152 can extend over the entire bottomsurface 108 of the base 102, as shown in the illustrated embodiment, orover a significant portion thereof. In some embodiments, it can bedesirable for the ingrowth-inducing covering 152 to cover a region thatis forward of and/or that encompasses the opening 150 so as to provide asecure attachment between a vessel and the base 102 in this region,which can assist in ensuring that access devices 144 inserted throughthe opening 150 are consistently and repeatedly directed to the sameportion of the vessel. For example, an attachment area AR may be definedover which it is desirable to provide a secure attachment to a vessel.The attachment area AR may be encompassed by a series of attachmentpassages 114 through which one or more attachment devices 116 may beadvanced through the sidewall of a vessel into the lumen of a vessel tocouple the vascular access device 100 to a vessel. The attachment areaAR likewise may be covered by the ingrowth-inducing covering 152 whichcan provide a further connection between the vascular access port 100and an outer layer of the vessel (e.g., the adventitia or media). Theattachment area AR can surround the opening 150, as shown.

In some embodiments, the base 102 can be provided with an adhesive (notshown) in addition to or instead of the ingrowth-inducing covering 152to provide a secure attachment between the base 102 and a vessel. Forexample, in some embodiments, the adhesive can comprise cyanoacrylate orfibrin glue.

It can be desirable for the vascular access port 100 to be configuredfor sufficiently secure attachment to a vessel such that the port 100remains fixed relative to the vessel when it is influenced by forcesfrom a needle or other access device 144. For example, attachmentdevices 116 coupled to the attachment passages 114, tissue attached tothe ingrowth-inducing covering 152, and/or a bond provided by adhesivescan resist relative longitudinal movement between the vascular accessport 100 and the vessel when a tip of the access device 144 is urgedforwardly along the funnel region 132 or forwardly within the channel134. Similarly, such attachment features can resist relative rotationalmovement between the vascular access port 100 and the vessel when a tipof the access device 144 presses downwardly on either of the wings 140.

In some embodiments, it can be desirable to constrain theingrowth-inducing covering 152 to the bottom surface 108 of the base102, such as when it is desired to discourage, inhibit, or prevent thebody 104 from attaching to surrounding tissue when the vascular accessport 100 is implanted in a patient. For example, vessels can be somewhatmobile relative to surrounding tissue, and it may be more desirable forthe vascular access port 100 to remain fixed relative to a vessel ratherthan relative to the tissue that surrounds the vessel. Accordingly, insome embodiments, the body 104 is relatively smooth. In otherembodiments, at least a portion of the body 104 can comprise aningrowth-inducing covering 152.

In some embodiments, at least a portion of the vascular access port 100can include a covering (not shown), such as a coating and/or an embeddedportion, that comprises one or more materials or agents that provideantiseptic, antimicrobial, antibiotic, antiviral, antifungal,anti-infection, or other desirable properties to the vascular accessport 100, such as the ability to inhibit, decrease, or eliminate thegrowth of microorganisms at or near a surface of the port. For example,in various embodiments, the vascular access port 100 can comprise one ormore of silver, platinum, gold, zinc, iodine, phosphorus, bismuth,alexidine, 5-flurouracil, chlorhexidine, sulfadiazine, benzalkoniumchloride, heparin, complexed heparin, benzalkonoium chloride, 2,3dimercaptopropanol, ciprofloxacin, cosmocil, cyclodextrin,dicloxacillin, EDTA, EGTA, myeloperoxidase, eosinophil peroxidase,fusidic acid, hexyl bromide, triclosan, polymyxin B, isopropanol,minocycline rifampin, minocycline EDTA, octenidine, orthophenyl phenol,triclocarban, triclosan, cephazolin, clindamycin, dicloxacillin, fusidicacid, oxacillin, rifampin, antibodies, peptides, polypeptides, freefatty acids, and oxidative enzymes. In some embodiments, the coatingand/or the embedded material may be separate or independent from (e.g.,non-coextensive with) the ingrowth-inducing covering 152. For example,in some embodiments, the ingrowth-inducing covering 152 is constrainedto the base 102 of the vascular access port 100, whereas anantimicrobial covering is constrained to the body 104 of the vascularaccess port 100.

In the illustrated embodiment, a forward face 156 of the body 104 risessmoothly from the base 102 and is angled rearwardly. As shown in FIG. 7,in some embodiments, the forward face 156 may generally follow a contourof the channel 134 and may be substantially parallel thererto. Forexample, the forward face 156 can be convexly rounded in a mannersimilar to the channel 134. The body 104 can smoothly transition fromthe forward face 156 into depressions 158 at either side thereof, whichcan provide for a relatively smaller surface area of the body to whichtissue might attach. The depressions 158 also can reduce the materialcosts associated with manufacture of the vascular access port 100.

Various parameters of the vascular access port 100 can be adjusted orselected to achieve a desired performance. For example, with referenceto FIG. 3, a maximum width WF of the funnel region 132 can be greaterthan a maximum width WB of the base 102. Such an arrangement may bedesirable where the vascular access port 100 is configured to be coupledwith a relatively small vessel, or where a relatively large target areaotherwise is desired. In various embodiments, the width WF is no lessthan about 1.0, 1.25, 1.50, 1.75, or 2.0 times the value of the widthWB.

In some embodiments, the width WB of the base 102 can be approximatelythe same as or smaller than a width of a vessel to which the vascularaccess port 100 is configured to be attached. In various embodiments,the width WB of the base 102 can be no less than about 6, 7, 8, 9, 10,11 or 12 millimeters, or can be no more than about 6, 7, 8, 9, 10, 11,or 12 millimeters.

In some embodiments, a height H of the vascular access port 100 can beadjusted or selected depending on the depth at which the port 100 is tobe implanted within the patient. For example, some embodiments of thevascular access port 100 may be well-suited for use with a shallowvessel, such as a vein associated with an arteriovenous fistula in aforearm, whereas other embodiments may be well-suited for use withdeeper vessels, such as the basilic vein in the upper arm. The depth atwhich the port 100 is located beneath a surface of the skin of thepatient also can vary from patient to patient due to differences inanatomy. Sites at which various embodiments of the vascular access port100 can be implanted include the cephalic, basilic, femoral, jugular,subclavian, or other suitable veins; arteries; fistulas; the stomach;other organs; or, more generally, any suitable structure where a walledmembrane encircles or encapsulates a region.

In some embodiments, it can be desirable for an implanted vascularaccess port 100 to be beneath the surface of the skin of a patient by asufficient amount to prevent tissue erosion, yet not so deep thatpalpation of the vascular access port 100 is difficult or providesinsufficient information regarding the position or orientation of theport. In various embodiments, a minimum distance between a surface ofthe skin of a patient and an implanted port is no more than about 3, 4,5, or 6 millimeters, is no less than about 3, 4, 5, or 6 millimeters, oris about 3, 4, 5, or 6 millimeters.

The height H can be defined as a minimum distance between the pinnacleregion 122 and the bottom surface 108 of the base 102, and the height Hcan be selected, adjusted, or otherwise configured so as to achieve adesired depth of the vascular access port 100 beneath the surface of theskin of a patient. In various embodiments, the height H can be nogreater than about 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15millimeters, or can be no less than about 2, 3, 4, 5, 6, 7, 8, 9, 10,11, 12, 13, 14, or 15 millimeters. In other or further embodiments, theheight H can be no more than about 0.5, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0,or 3.5 times the width WB of the base 102, or can be no less than about0.5, 0.75, 1.0, 1.5, or 2.0, 2.5, 3.0, or 3.5 times the width WB of thebase 102. In other or further embodiments, the angle α, as definedabove, can vary with the height H. For example, in some embodiments, theangle α increases with increasing height H.

It will be appreciated that various features of the embodiments of thevascular access port 100 discussed above can be altered or modified. Forexample, in some embodiments, the base 102 and the body 104 compriseseparate pieces that are joined to each other. For example, the base 102may comprise a relatively compliant material that can readily changeshape so as to conform to a surface of a vessel, while at least aportion of the body 104 (e.g., the funnel region 132) can comprise arelatively rigid material. In other or further embodiments, the cavity110 defined by the base 102 can be sized to receive any portion of acircumference of a vessel therein. Different sizes and configurations ofthe guidance passageway 130 are also possible, as further discussedbelow.

The vascular access port 100 can be implanted in a patient and used inany suitable methods. As mentioned above, it can be desirable to securethe vascular access port 100 to a vessel in such a manner that thebottom opening 150 defined by the guidance passageway 130 is fixedrelative to the vessel, which can allow the guidance passageway 130and/or the opening 150 to repeatedly direct an access device to the sameportion of the vessel.

FIG. 8 depicts an example of one such arrangement. The vascular accessport 100 is fixedly and directly secured to a vessel 200, whichcomprises three layers: the tunica adventita (or adventitia) layer 202,the tunica media (or media) layer 204, and the tunica intima (or intima)layer 206. The term “direct,” when used herein with reference tosecuring or attaching a vascular access port 100 to the vessel 200,means that some portion of the vascular access port 100 is in abuttingcontact with the vessel 200 and is fixedly attached thereto. In theillustrated embodiment, an attachment device 116 comprises a runningsuture that extends through each attachment passage 114 of the vascularaccess port 100. One or more loops of the suture can extend through allthree layers 202, 204, 206 of the vessel 200.

In certain embodiments, it can be desirable to ensure that one or moreattachment devices 116 extend through more layers of the vessel 200 thanjust the adventitia layer 202 (or a portion thereof), or statedotherwise, through the media and/or the intima layers 204, 206. Forexample, it has been found that attachment of certain ports solely tothe adventitia layer 202 (i.e., without attachment to other tissues) canresult in mobility of the ports relative to the media and intima layers204, 206. The ports may shift longitudinally and/or laterally relativeto the inner layers 204, 206 of the vessel 200 from such activities aspalpation of the ports during cannulation procedures or variousday-to-day occurrences. Such mobility of a vascular access port canpotentially result in the creation of multiple puncture sites in thevessel 200 over the course of repeated cannulations, which can weakenthe vessel wall over time and potentially result in an aneurysm, vesselstenosis, hematoma, and/or bleeding.

FIGS. 9A-9E depict various stages of an illustrative method forimplanting a vascular access port 100 in a patient 210 such that thevascular access port 100 provides direct access to a vessel within thepatient 210. The term “patient” is used broadly herein and includes anyanimal subject who can or does undergo some process or procedure,whether provided by another or self-administered, and the term is notlimited to an individual within a healthcare facility. The vascularaccess port 100 may be used with any suitable vessel, such as an artery212, a vein 214 (both shown in FIG. 9A), or an artificial graft (seeFIG. 14B). As previously discussed, the vessel may be at any of avariety of positions within the patient 210, such as the neck, the upperarm, the forearm, or the leg, and it may be located at a relatively deepor shallow position relative to the skin 216 of the patient. Numeroususes of an implanted port 100 are possible, including, for example,hemodialysis, chemotherapy, antibiotic therapy, total parenteralnutrition, pain management, aquapheresis, plasmapheresis, hydration, orlong-term therapies of any suitable variety. In the illustrated method,a vascular access port 100 is shown being implanted in a forearm of thepatient 210—specifically, the vascular access port 100 is shown beingconnected to a vein 214 that is associated with an arteriovenous fistula218 for use in hemodialysis. It is noted that the vein 214 is athree-layered vessel such as the vessel 200 depicted in FIG. 8, and thusmay be referred to hereafter as a vessel 200 to illustrate the moregeneral applicability of the procedures discussed.

With reference to FIG. 9A, an incision 220 can be made in the skin 216of the patient 210. In the illustrated embodiment, the incision 220 canbe from about 4 centimeters to about 5 centimeters in length. Theincision 220 can extend substantially parallel to the vessel 200, butcan be offset relative thereto (i.e., is not directly over the vessel200). In the illustrated embodiment, the incision 220 is offset from aposition directly over the vessel 200 by a distance of from about 2centimeters to about 3 centimeters. As discussed further with respect toFIG. 9E, such an orientation of the incision 220 can facilitate accessto the vascular access port 100 after the implantation procedure iscomplete. In other methods, the incision 220 can be directly over thevessel 200 and/or at an angle or entirely transverse relative thereto.The incision 220 can be made by a practitioner 224 using any suitabletechniques and instruments.

With reference to FIG. 9B, the vessel 200 can be exposed by removing,partially removing, or separating skin, fat, and fascial layers from theadventitia layer 202 of the vessel 200 at the site of the incision 220.Exposure of the vessel 200 can be maintained in any suitable manner,such as by the use of tissue spreaders 230.

With reference to FIG. 9C, an initial attachment of the vascular accessport 100 to the vessel 200 can be achieved at the front end or the backend of the vascular access port 100. In some procedures, an attachmentdevice 116 can be inserted through all three layers 202, 204, 206 (seeFIG. 8) of the vessel 200 and through an attachment passage 114 at eachof the front and back ends of the vascular access port 100 along alateral center of the port 100 prior to use of any of the remainingattachment passages 114. Initial attachment of the front end and/or theback end of the vascular access port 100 can assist in ensuring that adesired orientation of the vascular access port 100 is achieved andmaintained during the course of the implantation procedure.

As previously mentioned, any suitable attachment device (or devices) 116may be used in securing the vascular access port 100 to the vessel 200.The attachment devices 116 can include, for example, one or moresutures, pinch rings, hooks, or wires. Once an attachment device 116 isin a desired position, it can be securely tied, crimped, twisted, orotherwise fastened.

In the illustrated embodiment, the attachment device 116 comprises arunning suture, which can be looped through multiple attachment passages114. In the illustrated embodiment, a single running suture 116 is usedto secure the vascular access port 100 to the vessel 200. In otherembodiments, the suture 116 may extend through fewer passages 114 andone or more additional sutures 116 may be used. For example, aspreviously discussed, in some embodiments, a separate suture 116 issecured at each end of the vascular access port 100 prior to providingsutures in any of the remaining attachment passages 114.

Various options are available for securing one or more sutures 116 inplace. For example, in some procedures, a suture needle 232 can beinserted through the wall of the vessel 200 at a position near anattachment passage 114, and can then pass through the attachment passage114 after having passed through the vessel wall. A suture 116 associatedwith the suture needle 232 can then be tied using a surgical knot andthe excess suture trimmed. In other procedures, a suture 116 can bepositioned at a desired location within the wall of the vessel 200 suchthat at least one leg thereof protrudes from the adventitia layer 202.The protruding leg of the suture 116 can be received through a desiredattachment passage 114 of the vascular access port 100 as the port 100is brought into contact with the vessel 200. The suture 116 can then betied and trimmed. Either approach may be used to secure sutures 116through any desired number of attachment passages 114 of the vascularaccess port 100. Any other suitable suturing or attachment technique maybe used. In some embodiments, only a portion of the available attachmentpassages 114 are used.

With reference to FIG. 9D, additional sutures 116 can be used to securethe vascular access port 100 to the vessel 200 via any or all of theremaining attachment passages 114, as desired. In some embodiments, theattachment passages 114 are filled, such as with silicone, so as toprevent ingrowth of tissue. In other embodiments, the attachmentpassages 114 are left open, which can permit ingrowth of tissue thereinor therethrough.

With reference FIG. 9E, the site of the incision 220 can be closed inany suitable manner, such as, for example, via one or more sutures 234.As previously mentioned, the incision 220 can be offset from a positionthat is directly above the vascular access port 100. In sucharrangements, an access device 144 can be inserted through the skin 216to the vascular access port 100 via a surface insertion site 236 withlittle or no interaction with the site of the incision 220, or statedotherwise, without contacting any or much scar tissue at or beneath thesurface of the skin 216. In certain cases, this may assist in thecreation of an insertion tract that extends from the surface insertionsite 236 to the vascular access port 100, as discussed further below.

In certain embodiments, it can be desirable to wait for a period of daysor weeks after implantation of the vascular access port 100 beforeaccessing the vessel 200 thereby. The waiting period can providesufficient time for tissue ingrowth at the appropriate areas of thevascular access port 100, which can provide a more secure connectionbetween the vascular access port 100 and the vessel 200.

FIGS. 10A-10G depict various stages of another illustrative method forimplanting a vascular access port 100 in the patient 210 such that thevascular access port 100 provides direct access to the vessel 200 withinthe patient 210. Although the methods shown in FIGS. 9A-9E and 10A-10Gare depicted relative to the same site within the patient 210, it is tobe understood that the methods also may be used at other sites.

With reference to FIG. 10A, an incision 220 can be made in the skin 216of the patient 210, which in some embodiments can be from about 4centimeters to about 5 centimeters in length. The incision 220 canextend substantially parallel to vessel 200 and can be offset relativethereto. In some embodiments, the offset can be by a distance of fromabout 2 centimeters to about 3 centimeters.

With reference to FIG. 10B, the vessel 200 can be exposed by removing,partially removing, or separating skin, fat, and fascial layers from theadventitia layer 202 of the vessel 200 at the site of the incision 220.In some cases, a hemostat 240 can assist in this process. Exposure ofthe vessel 200 can be maintained in any suitable manner, such as by theuse of tissue spreaders 230.

With reference to FIG. 10C, a portion of the adventitia 202 can beisolated or separated from other portions of the vessel 200 in anysuitable manner, such as via one or more forceps 242. Each set offorceps 242 can be used to capture or gather up a portion of theadventitia 202 and/or fascia layers or fat that may not have beenremoved or spread apart by the tissue spreaders 230.

With reference to FIG. 10C, while the portion of adventitia 202 is beingheld in its separated state, a small incision 244 can be made therein inany suitable manner, such as via a scalpel or via scissors 246.

With reference to FIG. 10D, a hemostat 240 can be inserted through theincision 244 so as to slide between the isolated adventitia 202 and theremaining layers of the vessel 200. In instances, it can be difficult toseparate all of the adventitia 202 from the media layer 204 of thevessel 200. This, in the illustrated embodiment, the media layer 204 isshown, but is obscured by a thin layer of adventitia 202. The hemostat240 can be used to bluntly dilate a pocket 248 within the adventitia 202layer. Although not depicted, in some cases, the forceps 242 may be usedto maintain control of the adventitia 202 during formation of the pocket248.

In certain embodiments, the pocket 248 can be sufficiently large toreceive the vascular access port 100 therein, while in others, thepocket 248 can be slightly smaller than the vascular access port 100. Insome embodiments, the pocket 248 can have a length of no more than about2.0, 2.5, 3.0, or 3.5 centimeters, and can have a width of no more thanabout 70, 80, or 90 percent of a width of the outer diameter of themedia layer 204.

With reference to FIG. 10E, the vascular access port 100 can be insertedthrough the incision 244 into the pocket 248. In some cases, the forceps242 or other clamping devices are used to maintain control of theadventitia 202 during insertion of the vascular access port 100. Thevascular access port 100 can be introduced into the pocket 248 eitherrearward end first, as shown, or forward end first, and the port 100 canbe pushed to the end of the pocket 248 opposite the incision 244.

With reference to FIG. 10F, the adventitia 202 can cover all orsubstantially all of the implanted vascular access port 100 when it iswithin the pocket 248. Sutures 116 can be advanced through theadventitia 202, through the attachment passages 114, and through theremaining portion of the adventitia layer 202, as well as through theentirety of the media and intima layers 204, 206 to attach the vascularaccess port 100 to the vessel 200. Suture knots thus may be tied outsideof the adventitia 202. In other embodiments, the sutures 116 do not passthrough the separated portion of the adventitia 202 and may be tiedprior to being covered by the adventitia 202.

FIG. 10G depicts the site of the incision 220 in a closed configuration.The incision 220 can be closed in any suitable manner, such as in any ofthe manners described above with respect to FIG. 9E.

With reference again to FIGS. 10C-10F, in other methods, at least aportion of the adventitia 202 can be removed rather than forming thepocket 248 therein. The vascular access port 100 may be placed atop athin layer of the adventitia 202 at a site from which the at least aportion of adventitia 202 has been removed, and sutures 116 may bedirectly inserted through the attachment passages 114 and through thethinned adventitia layer 202, the media layer 204, and the intima layer206. The vascular access port 100 may, at least initially, be lessstable relative to the vessel 200 when it is implanted in this manner,rather than when it is inserted into the pocket 248.

FIGS. 11A-11E depict various procedures that may be performed relativeto an implanted vascular access port 100. As will be discussed, thevascular access port 100 can facilitate the creation of a buttonhole.The vascular access port 100 likewise can facilitate use of thebuttonhole once it is formed. These and/or other advantages of thevascular access port 100 will be apparent from the disclosure thatfollows.

Additionally, as previously mentioned, tissue may grow into or attach tovarious areas of the vascular access port 100. For example, vesseltissue may grow into the ingrowth-inducing covering 152. In someembodiments, skin tissue may grow into at least a portion of theguidance passageway 130, although such ingrowth is not shown in FIGS.11A-11E.

FIG. 11A depicts an embodiment of the vascular access port 100 that hasbeen implanted in the patient 210 in any suitable manner, such as viathe method depicted in FIGS. 9A-9E. The opening 150 of the guidancepassageway 130 is at or adjacent to the vessel 200. Specifically, in theillustrated embodiment, the opening 150 is at the adventitia layer 202of the vessel 200.

In the stage that is shown, a clinician 260 palpates the skin 216 tolocate and determine the orientation of the vascular access port 100.The term “clinician” is used broadly herein and includes any individualwho conducts a process or procedure relative to an implanted access port100, whether that individual is the individual in whom the access port100 is implanted (e.g., a patient) or someone else, and the term is notlimited to an individual within a healthcare facility. In theillustrated embodiment, the clinician 260 is using fingers to contactthe skin 216 located above the pinnacle region 122 of the palpationprojection 146. In other instances, the clinician 260 can palpate anyother suitable portion of the body 104 to determine the location (e.g.,depth) and orientation of the port 100. For example, the clinician 260may use one or more fingers and/or a thumb to contact the skin 216 thatis over or beside other portions of the palpation projection 146, or tosqueeze the skin 216 that is at either side of the wings 140. In stillother or further embodiments, a clinician may visually determine alocation and orientation of the port 100. Prior or subsequent to thestage shown in FIG. 11A, the clinician 260 can clean a surface of theskin with any suitable antiseptic so as to reduce the risk ofintroducing pathogens into the bloodstream of the patient.

FIG. 11B illustrates an embodiment of an access device 144 directlyaccessing a lumen 262 of the vessel 200 via the vascular access port 100for a first time. Although the fingers of the clinician 260 are notshown in FIG. 11B, the clinician 260 may continue to palpate thevascular access port 100 while inserting the access device 144 into theskin and the vascular access port 100. This can aid in achieving adesired alignment of the access device 144 with the guidance channel130. The clinician 260 also may make minor adjustments to an orientationof the vascular access port 100 by applying pressure thereto.

The access device 144 can comprise any suitable device configured forfluid communication between a position outside of the skin 216 and thevessel lumen 262 when the device has been introduced into the lumen 262via the vascular access port 100. For example, in various embodiments,the access device 144 can comprise a needle or a catheter. In manyembodiments, the access device 144 can be relatively rigid so as to beable to readily pass through the skin 216. Accordingly, in someembodiments, the catheter may be an over-the-needle catheter.

Standard needles that are presently used in hemodialysis or otherprocedures may be used with embodiments of the vascular access port 100,which may facilitate use of such ports. For example, standard protocolsfor making and using buttonholes in vessels via known freehand methodsmay be readily adapted to “device-assisted” buttonhole techniques thatemploy the vascular access ports 100, and this can take place withoutalteration to the instruments called for by the existing protocols.

As the procedural stage depicted in FIG. 11B represents an initialaccess of the vessel lumen 262, the access device 144 is shown as havinga sharp tip, which can allow the access device 144 to more readily beinserted through the unbroken skin so as to form an insertion tract 264,and also through an insertion site 266 of the vessel 200. As furtherdiscussed below, however, other embodiments of an access device 144 thathave blunt ends may be used after multiple access events have occurred.For example, as discussed hereafter, a sharp access device 144 can beused for a number of access events (e.g., 6, 7, 8, 9, or 10 accessevents) until an insertion tract has been formed through the skin of apatient, and a blunt access device 144 can be used thereafter.

In certain embodiments, the access device 144 can comprise a needlesized from 14 gauge to 20 gauge. As previously mentioned, the diameterand length of the channel 134 can be configured to direct the accessdevice 144 to a specific region of the vessel 200. This may be achievedby a relatively close fit between the channel 134 of the vascular accessport 100, which can provide for a predictable orientation at which theaccess device 144 will exit the channel 134 through the opening 150. Insome instances, it may be desirable for the channel 134 to be sized suchthat at least a small amount of space exists between an inner wallthereof and an access device 144 when the access device 144 is insertedtherein. This can prevent or reduce binding of the access device 144within the channel 134, which may be more likely to occur if tissue hasgrown into at least a portion of the channel 134. In some embodiments, abalancing or optimization may be achieved with respect to the spacingbetween the channel 134 and an access device 144 such that asufficiently tight fit is achieved to allow the vascular access device144 to be directed repeatedly to substantially the same area of thevessel 200 and to achieve hemostasis when the vascular access device 144is inserted into the vessel 200 while inhibiting, reducing theoccurrence of, or preventing binding of the vascular access device 144within the channel 134. In various embodiments, an inner diameter of thechannel 134 is larger than an outer diameter of an access device 144with which it is configured to be used by an amount within a range offrom about 0.25 gauge to about 3.0 gauge, from about 0.5 gauge to about2.0 gauge, from about 0.75 gauge to about 1.5 gauge, or from about 0.75gauge to about 1.25 gauge; by an amount that is no less than about 0.25,0.5, 0.75, 1.0, 1.25, 1.5, 1.75, 2.0, 2.5, or 3.0 gauge; or by an amountthat is no greater than about 0.25, 0.5, 0.75, 1.0, 1.25, 1.5, 1.75,2.0, 2.5, or 3.0 gauge. In some embodiments, the channel 134 is about 1gauge larger than access devices 144 with which it is configured to beused. For example, in the illustrated embodiment, the channel 134 may besized at approximately 14 gauge and the access device 144 can comprise a15 gauge fistula needle.

Other configurations for the channel 134 and the access device 144 arealso possible. For example, one or more of the channel 134 and theaccess device 144 may have geometries other than cylindrical. In certainof such embodiments, the geometries of the channel 134 and of the accessdevice 144 may be complementary to each other, whereas in otherembodiments, a cross-sectional shape of the channel 134 may be differentfrom a cross-sectional shape of the access device 144.

As previously mentioned, some protocols for the creation and use ofbuttonhole cannulation sites can require introduction of a needle into avessel at a designated acute angle. In some embodiments, the angle αdefined by the channel 134 (see FIG. 7) can be matched to this specifiedangle, and the channel 134 can constrain the access device 144 to enterthe vessel 200 at the angle α, such that the vascular access port 100can be configured for use with such protocols.

FIG. 11C illustrates a stage of the procedure after removal of theaccess device 144. The insertion site 266 is shown in a closed state, inwhich it is allowed to heal. Prior to closure and healing of theinsertion site 266, however, blood 268 can be permitted to exit thereby,and may fill the guidance passageway 130 and the insertion tract 264.The practitioner 260 can apply pressure above the vascular access port100 to close the insertion tract 264 until bleeding subsides at thesurface of the skin 216. For example, the practitioner 260 can applypressure while simultaneously applying a pad 269 (e.g., gauze) to theupper end of the insertion tract 264. As previously mentioned, the entrymouth 136 of the guidance passageway 130 can be configured to assist inachieving hemostasis. For example, the entry mouth 136 may be relativelyplanar, and application of pressure above the entry mouth 136 can causetissue surrounding the guidance passageway 130 to effectively seal theguidance passageway 130 about the entry mouth 136. In some embodiments,a two-finger technique may be used to close the insertion tract 264while applying pressure to the tissue positioned above the guidancepassageway 130. In some embodiments, pressure may be applied for aperiod of no more than about 5, 6, 7, 8, 9, or 10 minutes in order toachieve hemostasis.

A relatively tight attachment between the vascular access port 100 andthe vessel 200, such as may be achieved by tissue ingrowth within theattachment area AR (see FIG. 5) likewise can assist in reachinghemostasis. For example, tissue ingrowth about the opening 150 caninhibit or prevent blood 268 from seeping outwardly between the base 102of the vascular access port 100 and the vessel 200.

The procedures discussed with respect to FIGS. 11A-11C can be repeatedmultiple times. For example, with reference again to FIG. 11B, a secondaccess device 144 having a sharp tip can be inserted through theinsertion tract 264 toward the vascular access port 100 for a secondinsertion event. However, during the time between the first and secondaccess events and/or as a result of palpation of the vascular accessport 100 during the second access event, the vascular access port 100and the vessel 200 to which it is attached may have shifted relative tothe insertion tract 264 such that the channel 134 is no longer alignedwith the insertion tract 264. As the access device 144 is advancedthrough the insertion tract 264, the tip of the access device 144 cancontact the funnel region 132. The funnel region 132 then can direct thetip of the access device 144 into the channel 134 as the access device144 is further advanced through the insertion tract 264. In some cases,this redirection of the tip of the access device 144 relative to thevascular access port 100 may urge the insertion tract 264 and thechannel 134 into alignment with each other. Once the tip of the accessdevice 144 enters the channel 134, the channel 134 directs the tip ofthe access device 144 to the insertion site 266 of the vessel 200. Thevascular access port 100 thus can direct the access device 144 to thesame insertion site 266 via which the vessel lumen 262 was accessed inthe first access event.

FIG. 11D depicts the insertion tract 264 and the insertion site 266after multiple access events. As shown, the insertion tract 264 maybecome more well-defined over time, which may, for example, result fromthe formation of scar tissue or connective tissue. Similarly, theinsertion site 266 may become more well-defined over time such that itmay become easier to insert an access device 144 therethrough. Such aninsertion site 266 through a vessel wall can be referred to as abuttonhole access site, or more commonly, as a buttonhole. Accordingly,the insertion site 266 may also be referred to herein as a buttonhole266. In some embodiments, the well-defined insertion tract 264 and/orthe buttonhole 266 may be established after 6, 7, 8, 9, or 10 accessevents.

In other embodiments, the insertion tract 264 and the buttonhole 266 canbe formed by inserting an over-the-needle catheter (not shown) throughthe vascular access port 100. The needle portion can be removed and thecatheter portion can be left in place until the insertion tract 264 iswell-defined. The catheter then can be removed.

As previously discussed, the vascular access port 100 and the vessel 200may shift relative to the insertion tract 264 between access events.However, in certain embodiments, the funnel region 132 of the guidancepassageway 130 is sufficiently large that a distal end of the insertiontract 264 opens into, or extends through at least a portion of, thefunnel region 132 despite any such shifting. Accordingly, the vascularaccess port 100 may act as a mobile extension of the insertion tract264, which is configured to ensure that access devices 144 areconsistently directed to the buttonhole 266, despite any relativemovement between the insertion tract 264 and the vessel 200. In someinstances, however, relatively little shifting may occur between theinsertion tract 264 and the vascular access port 100, and an accessdevice 144 may be inserted through the insertion tract 264 and directlyinto the channel 134 with little or no contact with the funnel region132.

FIG. 11D also illustrates that a scab 270 may form over the insertiontract 264 between access events. The scab 270 may be removed prior to anaccess event. In other embodiments, a synthetic covering may be providedover or in place of the scab 270.

FIG. 11E illustrates the use of an access device 144 having a bluntdistal end after proper formation of the insertion tract 264 and thebuttonhole 266. The blunt end of the access device 144 can guide thedevice 144 through the insertion tract 264 and through the buttonhole266, and may do so in a less traumatic or more comfortable manner forthe patient 210. Use of a blunt-tipped access device 144 also can reducethe risk of striking through an opposing side of the vessel 200.

As previously mentioned, in some embodiments, an over-the needlecatheter can be used with an implanted vascular access port 100. Incertain procedures, a needle/catheter assembly can be inserted throughthe insertion tract 264 into the vessel 200 (e.g., the jugular vein) andthen the catheter can be advanced through the vessel to the desiredposition (e.g., the superior vena cava for certain central venous systemapplications). An infusion or other desired procedure can then beconducted. The catheter can be removed from the patient after completionof the procedure.

FIG. 12 depicts an embodiment of the vascular access port 100 that hasbeen implanted in the patient 210 via a method such as that depicted inFIGS. 10A-10G. A portion of the adventitia layer 202 of the vessel 200thus extends over the vascular access port 100. Accordingly, when anaccess device 144 is inserted into the vessel 200 via the access port100, it passes through the adventitia layer 202 before entering thevascular access port 100. Otherwise, procedures for creating and usingbuttonholes can be similar to those described above with respect toFIGS. 11A-11E.

FIG. 13 depicts an illustrative example of an embodiment of a buttonholeaccess site 266 in a vessel 200 that was formed by repeated insertion ofaccess devices 144 through an embodiment of a vascular access port 100.FIG. 13 is a photograph of a filleted portion of the vessel 200, and isshown from a bottom plan view thereof (i.e., a view directed toward theintima layer 206). A contour of the vascular access port 100 is visiblein the photograph, as are portions of a running suture 116 that extendthrough the initima layer 206.

In this particular example, the vascular access port 100 was implantedin a sheep for a period of 9 weeks. After a waiting period to permit fortissue ingrowth, a sharp needle was inserted through the vascular accessport 100 to access the vessel 200. Six (6) additional access events wereconducted thereafter using a sharp needle, followed by twelve (12)access events using a blunt needle. Accordingly, a total of nineteen(19) cannulations were performed. The access events were conducted at afrequency of three per week.

FIG. 14A depicts an embodiment of a hemodialysis system 300 thatincludes two vascular access ports 100A, 100B. Both of the ports 100A,100B are shown attached to a vessel 200 that is associated with anarteriovenous fistula 218. One port 100A is directed upstream such thata forward end thereof points in a direction opposite to the flow ofblood through the vessel 200, and the other port 100B is directeddownstream such that a forward end thereof points in the direction ofthe blood flow through the vessel 200. A fistula needle may beintroduced into each of the ports 100A, 100B and hemodialysis performed.The first port 100A can be an uptake port through which blood is removedfrom the vessel 200 and delivered to a hemodialysis machine, and thesecond port 100B can be a return port through which filtered blood isreturned to the vessel 200 from the hemodialysis machine.

In other embodiments, the hemodialysis system 300 can comprise only asingle vascular access port 100A or 100B. Hemodialysis may be conductedthereby via any suitable method, such as a single-needle hemodialysistechnique.

In still other embodiments, the hemodialysis system 300 includes morethan two vascular access ports 100A, 100B. A clinician thus can rotateamong the ports 100A, 100B, thereby leaving one or more of the portsunused during any given hemodialysis session.

FIG. 14B depicts another embodiment of a hemodialysis system 350. Theillustrated embodiment includes two vascular access ports 100A, 100B,but more or fewer ports are possible. Both of the ports 100A, 100B areshown attached to an artificial graft vessel 352 that serves as a shuntbetween an artery 212 and a vein 214. The graft vessel 352 can compriseany suitable material, such as e-PTFE. The ports 100A, 100B can beattached to the graft vessel 352 prior to its implantation, or may beattached to the graft vessel 352 after it has been implanted. Thehemodialysis system 350 can function similarly to the system 300described above, with the port 100A serving as an uptake port and theport 100B serving as a return port.

FIGS. 15A-15G illustrate another embodiment of a vascular access port400, which can resemble the vascular access port 100 described above incertain respects. Accordingly, like features are designated with likereference numerals, with the leading digits incremented to “4.” Relevantdisclosure set forth above regarding similarly identified features thusmay not be repeated hereafter. Moreover, specific features of thevascular access port 400 may not be shown or identified by a referencenumeral in the drawings or specifically discussed in the writtendescription that follows. However, such features may clearly be thesame, or substantially the same, as features depicted in otherembodiments and/or described with respect to such embodiments.Accordingly, the relevant descriptions of such features apply equally tothe features of the vascular access port 400. Any suitable combinationof the features and variations of the same described with respect to thevascular access port 100 can be employed with the vascular access port400, and vice versa. This pattern of disclosure applies equally tofurther embodiments depicted in subsequent figures and describedhereafter.

A width WF of the vascular access port 400 can be approximately the sameas the width WF of the vascular access port 100, but a width WB thereofmay be somewhat larger than the width WB of the vascular access port100. Accordingly, wings 440 may extend past a perimeter 406 of a base402 to a lesser extent than do the wings 140 of the port 100.Additionally, a radius of curvature of the base 402 can be larger than aradius of curvature of the base 102. A height H of the port 400 may beapproximately the same as the height H of the port 100.

The port 400 thus can be configured for use with a somewhat largervessel than the port 100. However, the port 400 can be implanted in apatient at approximately the same depth as the port 100 withoutsubstantially changing an observable profile at the surface of the skinof the patient, and can define a funnel region 432 that is only slightlylarger than the funnel region 132. Moreover, a channel 434 through theport 400 can be about the same size and configuration (including anangle thereof relative to the base 402) as the channel 134. The port 400thus may be configured for use with the same type of vessel as the port100, but with a different patient who may have larger vessels. By way ofexample, the port 100 may be configured for use with vessels having anouter diameter of approximately 7 millimeters, whereas the port 400 maybe configured for use with vessels having an outer diameter ofapproximately 9 millimeters. Similar methods for implantation and usethus may be performed for each port 100, 400.

A system for providing a selection of vascular access ports for a givenuse thus may comprise both of the ports 100, 400. For example, adistributor may offer both types of ports 100, 400 as alternatives toaccommodate varying needs of a customer, and/or may deliver one or bothports 100, 400 to a customer.

FIGS. 16A-16G illustrate another embodiment of a vascular access port500, which can resemble the vascular access ports 100, 400 describedabove in certain respects. A width WF of the vascular access port 500can be approximately the same as the width WF of the vascular accessport 400, but a width WB thereof may be somewhat larger than the widthWB of the vascular access port 400. Accordingly, wings 540 may extendpast a perimeter 506 of a base 502 to a lesser extent than do the wings440 of the port 400. Additionally, a radius of curvature of the base 502can be larger than a radius of curvature of the base 402. A height H ofthe port 500 may be approximately the same as the height H of the port400.

The port 500 thus can be configured for use with a somewhat largervessel than the port 400, and may be configured for use with the sametype of vessel as the ports 100, 400 but with a different patient whomay have larger vessels. By way of example, the port 500 may beconfigured for use with vessels that have an outer diameter ofapproximately 11 millimeters.

A system for providing a selection of vascular access ports for a givenuse thus may comprise any combination of the ports 100, 400, 500. Forexample, a distributor may offer two or more of the ports 100, 400, 500as alternatives to accommodate varying needs of a customer, and/or maydeliver one or more of the ports 100, 400, 500 to a customer.

FIGS. 17A-17G illustrate another embodiment of a vascular access port600, which can resemble the vascular access ports described above incertain respects. The vascular access port 600 can comprise a base 602that is devoid of attachment passages. Accordingly, the port 600 may beattached to a vessel by some method other than suturing or the like,such as via a biocompatible adhesive. However, in other embodiments, thevascular access port 600 includes attachment passages such as theattachment passages 114 discussed above.

The port 600 can include a guidance passageway 630 that varies from theguidance passageway 130 depicted in FIGS. 1-7. In particular, theguidance passageway 630 comprises a funnel region 632 that extends froma palpation projection 646 to an opening 650 in the base 602. Statedotherwise, the passageway 630 does not include a channel. In someinstances, the absence of a channel can prevent or inhibit binding of anaccess device 144 as it is inserted through the passageway 630. On theother hand, in some instances, the absence of a channel can result inless constraint on an orientation of the access device 144 as it passesthrough the opening 650, which may complicate the creation or use of abuttonhole in the wall of a vessel.

The funnel region 632 can define multiple angles relative to the base602. With reference to FIG. 17G, which represents a cross-section of theport 600 along a central vertical medial plane thereof, a front surfaceof the funnel region 632 can define a maximum angle β relative to thebase 602, and a rear surface of the funnel region 632 can define aminimum angle γ relative to the base 602. A central axis AX of theguidance passageway 630 can pass through a center of the opening 650along the central vertical medial plane at an angle relative to the basethat has a value defined by (β+γ)/2.

FIGS. 18A-18G illustrate another embodiment of a vascular access port700, which can resemble the vascular access ports described above incertain respects. A width WF of the vascular access port 700 can be lessthan a width WB thereof. Accordingly, wings 740 of the port 700 may notextend past a perimeter 706 of a base 702. In the illustratedembodiment, the outer edges of the wings 740 are substantially parallelto each other and extend upwardly from the base 702.

The port 700 can include a palpation projection 746 that fullyencompasses a funnel region 732 of the port. As shown, for example, inFIG. 18F, the palpation projection 746 can be substantially planar, andonly a small portion thereof may deviate from the plane defined thereby.A plane defined by the palpation projection 746 can define an acuteangle relative to a bottom end of the base 702. Additionally, a forwardface 756 of the port 700 can define an acute angle relative to thebottom end of the base 702. In the illustrated embodiment, the port 700includes a channel 734 that defines an acute angle relative to the base702.

FIGS. 19A-19G illustrate another embodiment of a vascular access port800, which can resemble the vascular access ports described above incertain respects. The vascular access port 800 can particularly resemblethe access port 700, but may be configured for deeper implantationwithin a patient. For example, in some embodiments, a base 802 of theport 800 and the base 702 of the port 700 have approximately the samewidth, yet the height of the port 800 can be greater than the height ofthe port 700. Each port 700, 800 may define a length that isapproximately the same, but acute angles defined by a plane across apalpation projection 846 and by a forward face 856 of the port 800 maybe greater than similar acute angles defined by a plane across thepalpation projection 746 and the forward face 756 of the port 700(compare FIGS. 18F and 19F). An angle of a channel 834 relative to thebase 802 can be greater than the angle defined by the channel 734.

The port 800 thus can be configured for use with a somewhat deeper yetsimilarly sized vessel, as compared with the port 700. By way ofexample, the ports 700, 800 may each have a width of approximately 7millimeters, yet the port 700 may have a height within a range of fromabout 2 millimeters to about 3 millimeters, while the port 800 may havea height within a range of from about 4 millimeters to about 5millimeters. Similar methods for implantation and use may be performedfor each port 700, 800.

Similarities and differences such as those just described with respectto the ports 700, 800 may also exist between these ports and the ports900 and 1000, which are depicted in FIGS. 20A-20G and 21A-21G,respectively. For example, the ports 900, 1000 each may have a width ofapproximately 7 millimeters, yet the port 900 may have a height within arange of from about 6 millimeters to about 7 millimeters, while the port1000 may have a height within a range of from about 9 millimeters toabout 10 millimeters. In the foregoing examples, the channel 734 of theport 700 may define an angle of about 20 degrees, a channel 834 of theport 800 may define an angle of about 25 degrees, a channel 934 of theport 900 may define an angle of about 30 degrees, and a channel 1034 ofthe port 1000 may define an angle of about 35 degrees. In otherembodiments, the channel 1034 may instead define an angle of about 30degrees.

A system for providing a selection of vascular access ports for a givenuse may comprise any combination of the ports 700, 800, 900, 1000. Forexample, a distributor may offer two or more of the ports 700, 800, 900,1000 as alternatives to accommodate varying needs of a customer, and/orthe distributor may deliver one or both ports 700, 800, 900, 1000 to thecustomer.

FIGS. 22A-22G illustrate another embodiment of a vascular access port1100, which can resemble the vascular access ports described above incertain respects. As shown in FIG. 22F, the port 1100 can comprise apalpation projection 1146 that is non-planar (i.e., that is notsubstantially planar).

FIGS. 23A-23G illustrate another embodiment of a vascular access port1200, which can resemble the vascular access ports described above incertain respects. The port 1200 can include a body 1204 having an uppersurface that is bowed in the transverse direction.

The port 1200 can include a palpation projection 1246 that borders afunnel region 1232. The palpation projection 1246 can comprise aradiused edge that protrudes very little from a body 1204 of the port1200. The port 1200 can further comprise a supplemental palpationprojection 1247, which is positioned at the forward end of theillustrated embodiment. The palpation projection 1247 can comprise arounded protrusion that extends upwardly and in a transverse direction,and can be spaced from the funnel region 1232 by a recess 1249.

The port 1200 can include a plurality of attachment passages 1214. Inthe illustrated embodiment, the attachment passages 1214 extend througha bottom surface 1208 of the port 1200 within the recess 1249 and withinthe funnel region 1232.

FIGS. 24A-24G illustrate another embodiment of a vascular access port1300, which can resemble the vascular access ports described above incertain respects. The port 1300 can particularly resemble the port 1200,but can include attachment passages 1314 that do not extend through abottom surface 1308 of the port 1300. Rather, the attachment passages1314 comprise vertical posts 1315 and recesses 1317 that extend into abody 1304 of the port 1300. The attachment passages 1314 can add heightto the port 1300, as compared with the port 1200. However, theattachment passages 1314 also are spaced from and are beneath a funnelregion 1332. Such an arrangement can avoid inadvertent insertion, orattempt at insertion, of an access device 144 into a vessel through anattachment passage 1314.

FIGS. 25A-25G illustrate another embodiment of a vascular access port1400, which can resemble the vascular access ports described above incertain respects. The port 1400 can particularly resemble the port 1200,but can include supplemental palpation projections 1447 at a forward endthat extend in a longitudinal direction. The palpation projections 1447can be spaced from each other by a recess 1449.

FIGS. 26A-26G illustrate another embodiment of a vascular access port1500, which can resemble the vascular access ports described above incertain respects. The port 1500 can particularly resemble the port 1200,but can include a body 1504 that defines a substantially rectangularprofile as viewed from the front or rear. Additionally, the port 1500can include a connection flange 1512 that fully encompasses the body1504. The connection flange 1512 can include a plurality of attachmentpassages 1514 that pass therethrough. The attachment passages 1514 thusdo not pass through a funnel region 1532 or a recess 1549.

FIG. 27A illustrates another embodiment of a vascular access port 1600,which can resemble the vascular access ports described above in certainrespects. The port 1600 can include a base 1602 that comprises a graftextension 1605, which can aid in securely attaching the port 1600 to avessel. In the illustrated embodiment, the graft extension 1605 can befixedly attached to a remainder of the base 1602 via one or more sutures116. Any other suitable method for attaching the graft extension 1605 tothe base 1602 may be used. The graft extension 1605 can comprise anysuitable material, which may be flexible so as to permit naturalfluctuations in the vessel diameter. The material may also promotetissue ingrowth. In some embodiments, the graft extension 1605 comprisese-PTFE. In the illustrated embodiment, a first side of the graftextension 1605 (not shown) is coupled with the port 1600 and a secondside 1609 is unattached thereto.

As shown in FIG. 27B, the graft extension 1605 can be positioned about aat least a portion of a vessel 200 and one or more attachment devices116 can be inserted through the port 1600, through the various layers ofthe vessel 200, and through the graft extension 1605 and then secured(e.g., tied off). Additional attachment devices 116 may also be usedrelative to the port 1600 in manners such as discussed above.

In some embodiments, the vascular access port 1600 can be used to repaira fistula. For example, in some embodiments, the base 1602 (e.g., thegraft extension 1605) can be positioned about an aneurism in a vesselwall.

In certain embodiments, the graft extension 1605 may be replaced with ahousing element (not shown) that is configured to encompass at least aportion of the vessel 200 in a manner such as that depicted in FIG. 27B.The housing element can comprise any suitable biocompatible material,and may be sufficiently rigid to prevent an access device 144 fromstriking through a side of a vessel that is opposite the port 1600.

In various embodiments, at least a portion of the graft extension 1605or the housing element can include a covering (not shown), such as acoating and/or an embedded portion, that comprises one or more materialsor agents that provide antiseptic, antimicrobial, antibiotic, antiviral,antifungal, anti-infection, or other desirable properties to thevascular access port 1600, such as the ability to inhibit, decrease, oreliminate the growth of microorganisms at or near a surface of the port.For example, any suitable covering material listed above may be used.

FIG. 28 illustrates an embodiment of a vascular access system 1700. Thesystem 1700 includes an artificial graft vessel 1701 and a vascularaccess port 1703 attached thereto. The vascular access port 1703 canresemble any of the access ports described above. However, in someembodiments, a bottom surface 1708 of the port 1703 may be devoid of aningrowth-inducing covering. The bottom surface 1708 may be provided withan adhesive to create a tight bond between the port 1703 and the graftvessel 1701. In some embodiments, a fluid-tight seal is provided betweenthe port 1703 and the graft vessel 1701, which can prevent blood orother fluids from seeping between the port 1703 and the graft vessel1701 during or after an access event. One or more attachment devices 116may be used to attach the port 1703 to the graft vessel 1701. The graftvessel 1701 can comprise any suitable material, such as, for example,e-PTFE.

FIG. 29 illustrates another embodiment of a vascular access port 1800.The vascular access port 1800 includes a flexible patch 1805 connectedto a base 1802 thereof. The patch 1805 extends outwardly beyond aperiphery of the body 1802. The patch 1805 can comprise any suitablebiocompatible material, and can promote tissue ingrowth therein. Forexample, in various embodiments, the patch 1805 comprises one or more ofDacron, e-PTFE, or polyurethane foam. The patch 1805 can be conformableto an exterior surface of a vessel to which it is attached, and it maybe attached to the vessel by one or more of sutures, clips, or othersuitable devices. The patch 1805 can be configured to encompass at leasta portion of the vessel to which it is attached.

FIG. 30 illustrates another embodiment of a vascular access port 1900.The vascular access port 1900 includes a supportive component 1924 and adirective component 1926 that have different properties, such as, forexample, different resistances to puncturing, duration times onceimplanted in a patient, or material costs. In various embodiments, eachof the supportive and directive components 1924, 1926 can form at leasta portion of one or more of a base 1902 and a body 1904 of the vascularaccess port 1900. For example, in the illustrated embodiment, each ofthe supportive and directive components 1924, 1926 help form the body1904, whereas, of the two, only the supportive component 1924contributes to the base 1902.

In some embodiments, the supportive and directive components 1924, 1926are configured to maintain a predetermined form within a patient fordifferent periods of time once the vascular access port 1900 has beenimplanted. For example, in some embodiments, the supportive component1924 is configured to be resorbed within a patient more quickly than isthe directive component 1926. For example, in various embodiments, thesupportive component 1924 is resorbed at a rate that is no more thatabout 1.5, 2, 3, 4, 5, 6, 7, 8, 9, or 10 times the rate at which thedirective component 1926 is resorbed, or the supportive component 1924is resorbed at a rate that is no less than about 1.5, 2, 3, 4, 5, 6, 7,8, 9, or 10 times the rate at which the directive component 1926 isresorbed. In some embodiments, the directive component 1926 isconfigured to resist resorption, and may remain within a patientindefinitely without being resorbed. In some embodiments, the supportivecomponent is configure to be fully resorbed within a period of no morethan about 1, 2, 3, 4, 5, or 6 months or no less than about 1, 2, 3, 4,5, or 6 months.

In various embodiments, one or both of the supportive and directivecomponents 1924, 1926 can comprise a resorbable material, such as, forexample, any suitable resorbable material described above. In other orfurther embodiments, the directive component 1926 can comprise anon-resorbable material, such as stainless steel, titanium, or the like.

A substantial portion of a guidance passageway 1930 can be defined bythe directive component 1926. For example, in the illustratedembodiment, an entire funnel region 1932 and an entrance end of achannel 1934 are formed by the directive component 1926. In contrast,only an exit end of the channel 1934 is formed by the supportivecomponent 1924. As it is more resistant to being resorbed, the directivecomponent 1926 can resist coring and scraping by a needle or otherinsertion device 144 for a longer duration, and thus can assist increating an insertion tract through the skin of a patient to abuttonhole, and in the creation of the buttonhole itself.

The supportive component 1924 can encompass a forward end of thedirective component 1926, as shown. The supportive and directivecomponents 1924, 1926 can be joined to each other in any suitablemanner. For example, the components 1924, 1926 can be adhered or weldedto each other. In some embodiments, the supportive component 1924 isovermolded onto the directive component 1926.

Tissue that replaces the supportive component 1924 can in turn supportthe directive component 1926 in a similar manner such that the directivecomponent 1926 can generally maintain the same orientation within apatient. In some embodiments, an outer surface of the directivecomponent 1926 (e.g., a surface opposite the guidance passageway 1930)can include an ingrowth-inducing covering such as the covering 152described above. Accordingly, as the supportive component 1924 isreplaced with tissue, the tissue can be firmly attached to the directivecomponent. Additionally, as with the ports discussed above, at least abottom surface 1908 of the vascular access port 1900 can include aningrowth-inducing covering 1952.

In some embodiments, different materials may be used for the supportiveand directive components 1924, 1926 as a cost-saving measure. Forexample, a less durable, less expensive material may be used for thesupportive component 1924 with little or no difference in theperformance of certain embodiments of vascular access ports describedabove. In some embodiments, the directive component 1926 may comprise acoating or layer of a material having intrinsic strength and/or that iscapable of imparting strength to the supportive component 1924.

FIG. 31 illustrates an embodiment of a system 2000 configured for theexternal treatment of blood. The system 2000 is similar to the system300 described above. The system 2000 includes two vascular access ports100A, 100B, which can resemble any of the ports described above. Both ofthe ports 100A, 100B are shown attached to a vessel 200 that isassociated with an arteriovenous fistula 218. One port 100A is directedupstream such that a forward end thereof points in a direction oppositeto the flow of blood through the vessel 200, and the other port 100B isdirected downstream such that a forward end thereof points in thedirection of the blood flow through the vessel 200, although otherarrangements are possible. A separate access device 144 (e.g., fistulaneedle or over-the-needle catheter) may be introduced into each of theports 100A, 100B via any of the methods described above and connected toa blood treatment system 2002 (e.g., hemodialysis machine) via anysuitable passageways 2004 (e.g., tubing).

Blood treatment then can then be performed. The first port 100A can bean uptake port through which blood is removed from the vessel 200 anddelivered to the blood treatment system 2002, and the second port 100Bcan be a return port through which treated blood is returned to thevessel 200 from the blood treatment system 2002. Accordingly, in use,blood is removed from the patient via an access device 144 that iswithin the first port 100A and delivered to the blood treatment system2002. The removed blood is treated in any suitable manner via the bloodtreatment system 2002. Treated blood is returned to the patient via anaccess device 144 that is within the second port 100B.

In other embodiments, the system 2000 can comprise only a singlevascular access port 100A or 100B. Blood treatment may be conductedthereby via any suitable method (e.g., a single-needle hemodialysistechnique). In still other embodiments, the system 2000 includes morethan two vascular access ports 100A, 100B. A clinician thus can rotateamong the ports 100A, 100B, thereby leaving one or more of the portsunused during any given blood treatment session.

As can be appreciated from the foregoing, embodiments of vascular accessports can be sized and dimensioned to reside within a patient andbeneath an outer surface of the skin of the patient. For example, thevascular access ports can be sized to fit between a vessel (e.g., anysuitable artery or vein, such as, for example, the cephalic, basilic,femoral, jugular, or subclavian vein) and the epidermis of an animalsubject.

Moreover, embodiments of one or more vascular access ports can beincluded in various embodiments of kits. For example, in someembodiments, a kit can comprise a vascular access port such as any ofthe ports described above. The kit can further include one or more of:one or more sutures or other attachment devices by which the port can beattached to a vessel, one or more synthetic grafts (which may bepre-attached to the port or separate therefrom), one or more pads ofingrowth-inducing material (which may be pre-attached to the port orseparate therefrom), and one or more additional vascular access ports ofthe same configuration and/or of one or more different configurations(e.g., different size, shape, etc.). For example, in some embodiments,the kit can include multiple ports such that a practitioner can selectone or more of the ports for implantation. In further embodiments, thekit can include ports of different sizes such that the practitioner canfurther select an appropriate port (or appropriate ports) based on theparticular anatomy of a patient and/or on the target location of theport (or ports).

It is noted that while many of the examples provided herein relate tothe use of vascular access ports with blood vessels, this method ofdisclosure is employed for the sake of convenience and efficiency, butshould not be construed as limiting of the types of procedures withwhich embodiments may be used. Indeed, embodiments of the apparatus,methods, and systems disclosed herein can be used with vessels otherthan blood vessels, such as, for example, vessels within thegastrointestinal tract. Accordingly, the term “vessel” is a broad termthat can include any hollow or walled organ or structure of a livingorganism, whether natural or synthetic.

It will be understood by those having skill in the art that changes maybe made to the details of the above-described embodiments withoutdeparting from the underlying principles presented herein. For example,any suitable combination of various embodiments, or the featuresthereof, is contemplated.

Likewise, although symmetries are present in the illustratedembodiments, some embodiments may be asymmetrical. For example in someembodiments, a guidance passageway of a vascular access port may extendgenerally at an angle relative to a vertical longitudinal plane throughthe port such that a funnel region may more readily receive an accessdevice therein at one side of the port as opposed to an opposite sidethereof. Such arrangements may be beneficial in some applications wherea port is implanted on a vessel that may more easily be reached from adirection that is not generally aligned with (e.g., nonparallel to) thevessel.

Any methods disclosed herein comprise one or more steps or actions forperforming the described method. The method steps and/or actions may beinterchanged with one another. In other words, unless a specific orderof steps or actions is required for proper operation of the embodiment,the order and/or use of specific steps and/or actions may be modified.

References to approximations are made throughout this specification,such as by use of the terms “about” or “approximately.” For each suchreference, it is to be understood that, in some embodiments, the value,feature, or characteristic may be specified without approximation. Forexample, although it is noted that in various embodiments, the height Hof the vascular access port 100 is no greater than about 2, 3, 4, 5, 6,7, 8, 9, 10, 11, 12, 13, 14, or 15 millimeters, it is understood that insome embodiments, the height H of the vascular access port 100 is nogreater than 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15millimeters.

Reference throughout this specification to “an embodiment” or “theembodiment” means that a particular feature, structure or characteristicdescribed in connection with that embodiment is included in at least oneembodiment. Thus, the quoted phrases, or variations thereof, as recitedthroughout this specification are not necessarily all referring to thesame embodiment.

Similarly, it should be appreciated that in the above description ofembodiments, various features are sometimes grouped together in a singleembodiment, figure, or description thereof for the purpose ofstreamlining the disclosure. This method of disclosure, however, is notto be interpreted as reflecting an intention that any claim require morefeatures than those expressly recited in that claim. Rather, as thefollowing claims reflect, inventive aspects lie in a combination offewer than all features of any single foregoing disclosed embodiment.Thus, the claims following this Detailed Description are herebyexpressly incorporated into this Detailed Description, with each claimstanding on its own as a separate embodiment. This disclosure includesall permutations of the independent claims with their dependent claims.

Recitation in the claims of the term “first” with respect to a featureor element does not necessarily imply the existence of a second oradditional such feature or element. Elements specifically recited inmeans-plus-function format, if any, are intended to be construed inaccordance with 35 U.S.C. §112 ¶ 6. Embodiments of the invention inwhich an exclusive property or privilege is claimed are defined asfollows.

1. A vascular access port configured to be implanted subcutaneously, the vascular access port comprising: a base that extends in a longitudinal direction and in a transverse direction, wherein the base is configured to be bowed in the transverse direction when the vascular access port is attached to a vessel so as to conform to a contour of a wall of a vessel, and wherein the longitudinal direction of the base is configured to run substantially parallel to a lumen of the vessel when the vascular access port is attached to the vessel; a guidance passageway that extends through the vascular access port and defines an opening in the base, wherein a central axis that extends through the guidance passageway defines an acute angle relative to a longitudinal length of the base, and wherein the acute angle points in a forward direction toward a front end of the vascular access port; and an ingrowth-inducing covering on the base, wherein at least a portion of the ingrowth-inducing covering is between the opening of the guidance passageway and the front end of the vascular access port, and wherein the ingrowth-inducing covering is configured to promote attachment of the vascular access port to a vessel so as to maintain the opening of the guidance passageway at a fixed position relative to a wall of the vessel.
 2. The vascular access port of claim 1, wherein the ingrowth-inducing covering encompasses the opening of the guidance passageway.
 3. The vascular access port of claim 1, further comprising a flange that at least partially encompasses the opening of the guidance passageway, wherein the flange comprises one or more attachment passages through which one or more attachment members can extend so as to attach the vascular access port to a vessel.
 4. The vascular access port of claim 3, wherein the flange comprises an attachment passage at the front end of the vascular access port.
 5. The vascular access port of claim 3, wherein the flange comprises a plurality of attachment passages that extend through the base, and wherein the attachment passages define a perimeter of an attachment area that is covered by the ingrowth-inducing covering.
 6. The vascular access port of claim 5, wherein the guidance passageway opening is within the attachment area.
 7. The vascular access port of claim 1, wherein the ingrowth-inducing covering is constrained to a bottom surface of the base of the vascular access port and an upper portion of the vascular access port is smooth so as to discourage ingrowth of fascia at the upper portion of the vascular access port.
 8. The vascular access port of claim 1, wherein the ingrowth-inducing covering comprises a plurality of titanium beads that have an average diameter of no greater than about 5 thousandths of an inch.
 9. The vascular access port of claim 1, wherein a height of the vascular access port is no less than about 0.5 times a width of the base.
 10. The vascular access port of claim 1, wherein the guidance passageway is devoid of closure apparatus.
 11. The vascular access port of claim 1, wherein the acute angle between the central axis of the guidance passageway and the longitudinal length of the base is no greater than about 60 degrees.
 12. The vascular access port of claim 1, further comprising a graft extension, a housing, or a patch configured to encompass at least a portion of a vessel in order to secure the vascular access port to the vessel.
 13. The vascular access port of claim 1, wherein a portion of the vascular access port that is configured to be attached to the vessel comprises a first resorbable material.
 14. The vascular access port of claim 13, wherein the guidance passageway comprises a non-resorbable material or a second resorbable material that has a slower resorption rate than the first resorbable material.
 15. A vascular access port comprising: a base that extends in a longitudinal direction and in a transverse direction, wherein the base is configured to be bowed in the transverse direction when the vascular access port is attached to a vessel so as to conform to a contour of a wall of a vessel, and wherein the longitudinal direction of the base is configured to run substantially parallel to a lumen of the vessel when the vascular access port is attached to the vessel; a guidance passageway that extends through the vascular access port, wherein a central axis defined by the guidance passageway defines an acute angle relative to a longitudinal length of the base, and wherein the acute angle points in a forward direction toward a front end of the vascular access port; and an attachment passage forward of the guidance passageway through which an attachment device can extend to connect the vascular access port to a vessel so as to resist forward movement of the vascular access port relative the vessel as an access device is advanced toward or through the guidance passageway.
 16. The vascular access port of claim 14, wherein the attachment device comprises one of a suture, a pinch ring, a hook, and a wire.
 17. The vascular access port of claim 14, wherein the guidance passageway defines an opening in a bottom surface of the base.
 18. The vascular access port of claim 14, wherein the guidance passageway comprises a funnel region that decreases in size toward a channel, and wherein the funnel region is rearward of the channel.
 19. The vascular access port of claim 14, further comprising an additional attachment passage at a rearward end of the vascular access port.
 20. A kit comprising: the vascular access port of claim 14; and one or more of a suture, a synthetic graft, and one or more additional vascular access ports.
 21. A method of implanting a vascular access port, the method comprising: providing a vascular access port that comprises a guidance passageway extending therethrough, wherein a proximal opening of the guidance passageway is larger than a distal opening thereof such that the guidance passageway can direct an access device inserted therein toward the distal opening; preparing an incision in the skin of a patient so as to expose a vessel; fixedly attaching the vascular access port to the vessel with the distal opening facing the vessel; and closing the incision such that the vascular access port is entirely below a surface of the skin.
 22. The method of claim 20, wherein fixedly attaching the vascular access port to the vessel comprises orienting the guidance passageway such that a central axis thereof defines an acute angle relative to a lumen of the vessel.
 23. The method of claim 21, wherein fixedly attaching the vascular access port to the vessel comprises securing an attachment device to both the vascular access port and the vessel at a position forward of the distal opening of the guidance passageway. 